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We additionally summarize the evidence by domain and certainty level in a structured Supplementary Table 6, explicitly separating relatively robust short-term metabolic evidence from more exploratory reproductive and periconception safety findings

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Sensitivity analyses We conducted prespecified sensitivity analyses to evaluate the robustness of the target trial emulation and to probe key threats to validity, including residual confounding, reverse causation (protopathic bias), and time-related biases

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